Pilates and Plyometrics to prevent Achilles Rupture: Insights from an Achilles Rupturee

by Melanie Byford-Young on August 28, 2010

In Spring of 2010, Melanie Byford-Young ruptured her left achilles tendon. She has taken the time to share her insights with us….thanks Mel.

First of all, it is a bad idea to rupture your Achilles tendon! Don’t try it, even if all the cool kids are doing it these days! But if you are going to do it, I highly suggest rupturing your left ankle- much easier to drive in North America.

I am now part of the Achilles rupture club; I am one of five in our ‘chapter’, and we are not accepting any new members. Two members ruptured while dancing and three of us ruptured playing tennis. Of the tennis players, one ruptured after serving, one running to the net, and me, while doing a split step. Makes you think.

My whole life changed in a microsecond Wednesday April 14, 8:32pm. I was 72 minutes into an awesome tennis lesson when I did a small split step, heard the loud pop and a fierce sting. I hoped that someone at the back of the court was being a jerk and had fired a tennis ball at me, but no. I knew what it was immediately. Everyone on the court heard the pop, and my poor instructor Sonia came running over in disbelief. Ice and phone calls to all of my PT friends to find out who is the best surgeon and where they would go. I did not go into shock, so I drove myself home, had a bath, got dressed with clean ‘presentable’ undies, and then drove myself to the Emergency room. Kevin was in Florida, and I was full of adrenalin, so there was no stopping me.

My brain went immediately into ‘uber problem solving mode’ and I wanted surgery NOW. I called in every favor possible, pushed, pulled and persisted, and fortunately, I only had to wait until Friday. If I’d had to wait longer, I would have driven myself and everyone around crazy. I was still running on lots of adrenalin! My AWESOME surgeon, Dr Crary, did his magic. My friends Annie and Michele rallied and got me to and from the hospital, and took care of me until Kevin got home. Thank God for great friends!!! Thank God for having done Pilates and being strong enough to get around on crutches!!!

There can never be good timing for an accident, but this was VERY bad timing! Very bad! I was scheduled to fly to Toronto, Singapore and the Philippines in three weeks to teach. The E.R. doctor just looked at me and said “Well, that’s not going to happen”. This was the beginning of a one year rehab. FYI- the greatest risk of re-rupture is between 10-20 weeks post surgery. This is when the tensile strength of the tendon is somewhere between 40-60% of normal but the patient is starting to move around more and feels better!!!

What predisposes someone to rupturing their Achilles? Usually it is men in their mid 40’s who are weekend warriors with tight calves who rupture during an explosive activity like tennis, squash, baseball, basketball etc. That description does not fit any of my group, nor David Beckam!!! Age, short calves, long calves (excessive dorsiflexion prior to heel during the gait cycle), a neural issue, maybe some medications, malicious guardian angels…… who knows?

First rule: do exactly what your surgeon says. I had to spend 10 days post-op with my foot elevated all the time. What this time did afford me was insight into how much I missed everyone at work, how lucky I am, and that I do not like to be held down!! My friends immediately spoiled me with deliveries of healthy food, books, coming over to play games, and taking me grocery shopping. Bad idea to go grocery shopping in the first week post surgery!

Next came three more weeks of non- weight bearing in a very attractive purple and green cast. Again, very thankful for a strong midback, arms and abs- you need them for crutch walking and getting in and out of the bath.

Dr Crary said no airplanes for 6 weeks post- op because of the risk of DVTs; that was enough to scare me and call off the trip. Sorry Joe and Vivian!!

Timing was that I could still go to Australia safely on week 9, wearing compression stockings and taking asperin in case of clots.

Second Rule: You need time to heal and you must rest. It was laughable that getting up stairs was enough to demand a nap, and working for several hours required several hours of napping to recuperate. Apparently it doesn’t matter how head strong (a.k.a. stubborn) you are, nor how much adrenaline you have, you need to sleep. If you have your foot down too long, it takes ages for it to settle and when it swells inside your cast, it is not so good! A rolling desk chair, a wheel chair, and great friends enabled me to work part time, and I was so thankful for that. BUT…. You need to rest (and I do say that from the perspective of someone who didn’t rest enough and paid the price for it! Carole, Kevin and my Mom are rolling their eyes right now).

Third Rule: Get a great physio/ therapist and do Everything they say. I am so fortunate to know a bunch of AMAZING physios/ therapists/ clinicians who I trust implicitly. My biggest issue was that I could not go to everyone who I respect and adore. I began my therapy while in my cast, making sure that my spine and hips stayed healthy, that my nerves could glide, that energy would still run through my calf and Achilles to my foot. It was critical to manage the effects of being on crutches.

Pilates-wise, I used the Cadillac and chair to keep me moving starting in week two. It felt amazing to be able to move with the leg supported. Because you spend so much time with your leg elevated, your back is always in flexion. Swan dive and Mermaid felt fantastic. Prone One Leg Kick helped me unwind my hip flexors which were on overdrive, and Side Leg Lift Series helped mobilize my hip and prepare my glutes to work again. From week five post-op, I was able to get on the reformer and begin small range footwork and Sleeper on light springs.

I will be ‘hanging out’ with my physio for months to come, and look forward to getting to do athletic return to tennis style drills somewhere near the end of the year. Now at week twelve, I can begin to load on more springs with footwork, and start to do more Ankle Lower and Lift, focusing on the eccentric strength.

Fourth Rule: DO PILATES TO PREVENT AN ACHILLES RUPTURE or TO MANAGE YOUSELF IF YOU DO RUPTURE YOUR ACHILLES!!!!

Here are the juicy tidbits for pilates instructors and therapists.

While this may sound sick, I have enjoyed learning the lessons associated with this injury, and observing the emotions that crop up. Maybe ‘appreciated’ is a better word than ‘enjoyed’. It is a crazy experience to not be able to balance on your injured leg, and not to be able to compensate or figure out how to do it for 7-10 days. I am a coordinated, strong person, who understands motor patterns and balance mechanisms. I literally could not center my rib cage over my pelvis and leg to balance. It did not help to contract my abs/ inner thighs/ glute medius nor just to visualize centering over my midfoot. I now understand what that ‘lost or empty’ sensation is that clients have described. What did work was stepping to the side to balance instead of trying static standing or stepping forward. Interesting, eh?

And the emotions; the fear that goes along with the threat of re-rupture is intense. It was so valuable to be able to talk with Dr Crary, and to know that I was in good hands in my physios/ therapists care. You need an outside brain to be in charge of doing enough but not too much.

If you are working with clients who have ruptured, make sure you know the surgeons protocol and stick to it exactly!!!!! Your client is trusting you.

Prevention of ruptures (if possible): Eccentric training and plyometrics!!!! Awesome calves that have strength through range of motion. Balance and proprioceptive challenge. Great dynamic control of the feet, knees, hips (gotta get a Bum), pelvis and spine. Symmetry, suppleness and strength.

One of my great joys is teaching the fabulous gang in my Wednesday ‘Instructor Only’ class; the theme became ‘everything you need to have to cope with being on crutches’, and ‘preventing Achilles ruptures’. There were some sore tushes, calves and arms! Great work girls.

Management of Achilles Ruptures: Eccentric training and plyometrics!!!! Awesome calves that are neither too long nor too short. Great dynamic control of the feet, knees, hips (gotta get a Bum), pelvis and spine. Balance and proprioceptive challenge. Symmetry, suppleness and strength. Sound familiar?

Fifth Rule: You need insurance. One last major point….. Insurance. I have learned a lot about insurance. First of all, get some, some how, some way. That, or put a good amount of money away inyour just in case fund. You have no choice but to have medical intervention when you have a ruptured Achilles. Even with good insurance, an injury like this will cost you thousands of dollars in medical expenses. Medical insurance does not provide income replacement. Most disability plans kick in after three or more months of not working, but do not cover you for the weeks you would miss typically miss this kind of injury. Ironically, we were literally in the process of signing up for Aflac when this injury happened. If we had signed up with Aflac one week earlier, most of my medical costs would have been covered, and I would have been eligible for income replacement starting the day my injury occurred. This kind of support would have alleviated many worries. Please look into short term disability coverage.

I hope this gives you some insight into life post Achilles rupture. There is a lot of good information on the net, but most importantly, ALWAYS follow the surgeons protocol! Every surgeon’s approach is different so respect it!

I need to thank so many people for supporting me and putting up with me over the past 12 weeks. First and foremost is Kevin my wonderful husband!!!! Then my wonderful family, Leslie, Jean, Carole, Daphna (my personal chef) and all the girls at Pacific Northwest Pilates. All of my clients who have been patient with me (and laughed at me when I came back too soon). Michele, Annie, Lori. Dr Crary, Matt Walsh, Dr Sheila Murphy, Debbie Lehner, Lisa Seitz, , Dr Chris Lord…. And many more! Thanks to everyone.

Melanie,
Great article — thanks for being so candid about your experience! It’s interesting that you included mention of a “lost” or “empty” sensation. Although I experience this much less frequently and during fewer exercises, this inability to sense and maintain control throughout a complete range of motion is one of the most frustrating aspects of rehab and on-going attempts to get back to “normal” after hip replacements. I’ve had the great good fortune to work with Leslie, whose patience and ability to come up with new ways to work with this are truly awesome. I look forward to the day when that “6 degrees of separation” from my own body is finally and forever banished!
It is most excellent to see you on the mend!
Linda

Thanks for sharing. So sorry to hear about your suffering. Sounds like you learned a lot! Hoping to see you this fall and will be at RCCB classes next June for sure. I am still doing so much better with my hip, many thanks for your help. Worked with a college freshman football athlete on scholarship this summer suffering from chronic achilles tendinitis. Manual myofascial techs coupled with footwork, plyos and pool plyos really worked for him – lots of fun. Take care. Beth

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Melanie Byford-Young, BHSc. PT
Co-Founder and Co-Owner, Pacific NW Pilates
Master Instructor Trainer of Rehabilitation, STOTT PILATES.
Melanie has been pioneering the use of STOTT PILATES to assist with physical rehabilitation and therapeutic conditioning for over eight years. Read more

Leslie Braverman, Co-Founder and Co-Owner, Pacific NW Pilates Lead Instructor Trainer, STOTT PILATES.
Leslie was a 15-year professional dancer when she was led to STOTT PILATES because of an injury – she credits pilates for prolonging her career. Read more